Towards a Decolonial Discussion on Mental Distress: Early Soviet Ideas of Consciousness through Vygotsky, Vološinov and Bakhtin Perspectives

ABSTRACT

Capitalism plays an important role in framing mental distress, which is widely discussed in the field of mental health, since it is based on the discourse and actions guided by biomedical ideology, the medicalisation and an individualistic perspective, in addition to being reduced to biological aspects. Therefore, from the conceptions of consciousness proposed by Vygotsky, Vološinov and Bakhtin, we will be able better to understand some aspects related to mental distress in a dialogical perspective, as well as weave possible decolonial reflections. The article enables a synthesis of the initial ideas of Vygostky and Vološinov about the formation of human consciousness, as well as the way in which these ideas were approached by Bakhtin in the analysis of the novels, through the works Problems of Dostoevsky’s Poetics and Rabelais and His World and how such ideas allow a discussion about mental distress in a decolonial bias.

KEYWORDS:
Mental Health; Mental Distress; Consciousness; Decoloniality; Dialogic Discourse Analysis

RESUMO

O capitalismo desempenha importante papel na abordagem do sofrimento psíquico, discutido amplamente no campo da saúde mental, visto que este se baseia no discurso e nas ações pautados pela ideologia biomédica, norteada pelo viés da medicalização e por uma perspectiva individualista, além de ser reduzido apenas a aspectos biológicos. Portanto, a partir das concepções de consciência propostas por Vygotsky, Voloshinov e Bakhtin, poderemos compreender melhor alguns aspectos relacionados ao sofrimento psíquico numa perspectiva dialógica, bem como tecer possíveis reflexões decoloniais. O artigo possibilita uma síntese das ideias iniciais de Vygostky e Voloshinov acerca da formação da consciência humana, bem como a maneira como essas ideias foram trabalhadas por Bakhtin na análise dos romances, através das obras Problemas da poética de Dostóievski e A cultura popular na Idade Média e no Renascimento: o contexto de François Rabelais e como tais ideias viabilizam uma discussão sobre o sofrimento psíquico num viés decolonial.

PALAVRAS-CHAVE:
Saúde mental; Sofrimento psíquico; Consciência; Decolonialidade; Análise dialógica do discurso

Initial Considerations¹

Two specters are haunting the world today, State and Capital. Together they degrade human and nonhuman beings into subjects, commodities; they transform Being into Unbeing. […] But the task of decolonizing intellectual history should be to offer us pathways towards overcoming State and Capital.

Milinda Banerjee

In accordance with the ideas of the Critical Theory,² proposed by the Frankfurt School in the 1930s, which criticised the modes of domination in modern society, Milinda Banerjee (2021) argues that in our current context, the State and Capital are transforming us into mere commodities or products, into lifeless beings, into objects, shaped by the needs of capitalist society. Contemporary capitalism relies on the State to maintain and enhance capital value, even at the expense of human life, and this is a critical concern.

Banerjee (2021) suggests a crucial task for overcoming these two ‘spectres:’ the task of decolonising this intellectual history, which should primarily focus on finding ways to overcome these structures of power and oppressive forces. This means seeking alternatives that can liberate societies from the dominance of these entities and create a more just and equitable future, once “Decolonial studies share a systematic set of theoretical postulates that revisit the question of power in modernity” (Quintero, Figueira, Elizalde, 2019, p. 4). ³

These reflections are at the core of mental distress,⁴ which are shaped by the dominant biomedical model of Psychiatry (Kraepelin, 1893; Engel, 1977), which assumes that mental distress originates in the organism, that is, it is a biological-based brain disease. Andreasen (1985 apudDeacon, 2013, p. 847) corroborates with this idea affirming that “(a) mental disorders are caused by biological abnormalities principally located in the brain, (b) there is no meaningful distinction between mental diseases and physical diseases, and (c) biological treatment is emphasized.” Moreover, it is characterised by medicalisation and an individualistic perspective - where problems are typically attributed to the individual, and in some cases to their family, but rarely to the community - ignoring broader social, cultural, or economic factors that also impact mental health. That is to say, it pathologises individuals who may be responding rationally to intolerable conditions.

Those who accept capitalism simply as given reduce mental distress to biological aspects and Bruce Cohen (2016) highlights the growing influence of pharmaceutical corporations in shaping new categories of mental distresses and advocating solutions through pharmacological intervention. For him, the biomedical model of Psychiatry has become the final authority on defining and treating mental pathologies, significantly aligning itself with the interests of the pharmaceutical industry, which he refers to informally as big pharma, thus driving the mental health agenda.

However, mental distress is complex and multidimensional, requiring an approach that considers a broad range of factors and perspectives, going beyond strict biological or psychiatric reductionism. A comprehensive and interdisciplinary understanding of the distresses that affect the subjective inner life of an individual’s mind - that is, his/her consciousness (Goldstein, 2020) - is essential. This understanding should take into account not only biological aspects but also social, cultural, historical, and ethical dimensions.

This perspective is in accordance with the principles of Psichiatria Democratica [Democratic Psychiatry] - advocated by Franco Basaglia (2005) - which emphasized an anti-institutional approach to Psychiatry and the promotion of community-based forms of care. It is advocated a non-medicalising understanding of mental distress, grounded in attentive listening, the preservation of human dignity, and the social inclusion of the individual, while highlighting the significance of social and cultural determinants of mental health. Inspired by the Gramscian perspective, Basaglia stressed the importance of comprehending the specific social and historical context in which consciousness and individual action are formed, recognizing that a person’s subjectivity cannot be dissociated from the concrete conditions of their existence (Basaglia; Lovell; Scheper-Hughes, 1987).

In this sense, the theoretical contributions of Lev Vygotsky, Valentin Vološinov, and Mikhail Bakhtin further expand Basaglia’s vision by offering conceptual tools to understand how consciousness - and, by extension, mental distress - is socially constructed and dynamically shaped through human interaction and historical conditions. This perspective was developed precisely in the context in which these early Soviet researchers began to challenge the reductionist approaches inherent in the study of human consciousness.

Influenced by, inter alia, the Marburg neo-Kantian Paul Natorp’s (1888) ideas, - that the content that forms human consciousness originates from the society in which it is embedded and consciousness evolves through activities directed toward culture, which represents the reduction of individual life to the life of society - Vygotsky, Vološinov, and Bakhtin questioned some trends within Soviet Psychology, which treated higher mental functions only through the natural sciences. Vološinov and Bakhtin, who joined the dialogue among many intellectuals of the time, also warned against the inappropriate use of natural science methods in a field where the methods of the human sciences should be applied (Brandist, 2007).

For Vygotsky, Vološinov, and Bakhtin, it would be impossible to explain the functions inherent to the human solely through the natural sciences, especially when dealing with our consciousness, since we are active subjects, we are not merely individual subjects, but we are mutually imbricated and connected beings, i.e., we are social beings. Various other aspects permeate and influence our mental functions and, consequently, our behaviour: time, space, other subjects, among other aspects, intervene in orienting our actions, and we end up acting and reacting in a unique and singular way, based on our axiological position in the world.

Thus, there is a consensus that consciousness is constructed from the experiences that surround individuals, which are subsequently transformed into language utilised to forge interpersonal relationships with others. Consequently, it is understood that both positive and negative experiences significantly influence the signs that populate our consciousness. When considering individuals with mental distresses, such as depression, it becomes evident that they have been affected by negative experiences that compromise mental well-being, and consequently, what might be regarded as their mental health.

Therefore, through colonialism, the medical model was spread to societies that had other traditional ways of dealing with forms of consciousness and behaviour considered unconventional or “deviant.” Historically, colonial powers imposed psychiatric practices in their colonies primarily by establishing psychiatric institutions similar to those in the colonising countries. This process was more limited in scope and focused on replicating institutional models and the current movement toward global mental health is far more extensive and organised. Furthermore, it involves the rapid dissemination of psychiatric interpretations and treatments to address suffering and mental health issues in various parts of the world (Beresford; Rose, 2023).

Given the imposition and global dissemination of psychiatric models shaped by colonial powers, it becomes essential to question and decolonise these dominant perceptions regarding mental distress, and considering Craig Brandist’s (2021, p. 226) ideas that we should “play the role of Bakhtin’s novelist, giving voice to subalternised perspectives, bringing the various voices into dialogue, facilitating the critique of dominant perspectives, exposing their assumptions, ideological bases and imbrication with structures of power.” Therefore, it is important to ensure discussions of mental distress not be reduced to biological aspects alone, turning a blind eye to problems that lie beyond this share. Consequently, it is crucial to reflect on the fact that suffering should not be individualised but recognized as originating from social factors.

In the perspective that “It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness” (Karl Marx apud Howard; King, 1985, p. 5), this study aims to weave dialogical reflections on the approach and definition of consciousness through Vygotsky, Vološinov and Bakhtin and, from their perspectives, make decolonial reflections on mental distress.

1 Consciousness: Some Reflections from Vygotsky, Vološinov and Bakhtin

Consciousness was often discussed as a unique characteristic of humanity, and Vygotsky, Vološinov, and Bakhtin contributed uniquely to the debate with their insights into human consciousness. Some recent studies (Emerson, 1983; Wertsch, 1991; Brandist, 1999, 2007; Kellogg, 2009; Carvalho; Araújo; Ximenes; Pascual, 2010; Leiman, 2011; Cornejo, 2012) aim to point out some contributions and confluences between the ideas of the theorists of the so-called Bakhtin Circle and the ideas of their contemporaries, in this case, with Vygotsky. According to Brandist (2007, p. 79) “there were many shared themes such as the centrality of dialogue to the development of human consciousness, the understanding of inner speech as internalised dialogue and the emergence of culture from primordial mythical thinking to mention but three.” Thus, this section aims to weave some reflections and point out some intersections concerning the idea of consciousness from Vygotsky and the works of Vološinov and Bakhtin.

1.1 Conceptualising Consciousness: Vygotsky Perspective

At the beginning of the 20th century, in the earliest forms of Soviet psychology, just the Scientific psychology was considered, which was reduced to Physiology, Neurology, or Reflexology, played a dominant role maintaining the monism of German physiologists (Carvalho; Araújo; Ximenes; Pascual, 2010). Vygotsky questioned the foundations of Psychology that naturalised human behaviour and had its genesis in the biological sciences, in the phenomena of heredity or physical constitution.

Vygotsky began to implement some theoretical-methodological changes regarding the conception of psychological processes, while he was still working in a research project at the Institut eksperimental’noi psikhologii [Institute of Experimental Psychology], IEP, in Moscow and began attempting to resolve an issue in the “crisis of psychology,”⁵ since psikhotekhnika⁶ created a link between psychology and social practice, especially in the context of industrialization and mass communications. And it was the first time, social practice was used as a criterion to validate psychological theories, by explaining phenomena through the performance of practical tasks and developmental predictions. However, Vygotsky did not work on it (Brandist, 2007).

The central focus of Vygotsky’s research throughout his life as a psychologist concerns the problem of consciousness as a distinctive feature of humanity, although he never arrived at a completed theory (Zavershneva, 2014, 2016), probably due to his early death. Vygotsky views consciousness as a system of higher mental functions and their interrelationships (Bakhurst, 2007). Furthermore, Vygotsky (1997) stated that what develops in ontogenesis is not the individual mental process (such as memory or attention), but their interfunctional relationships. Consciousness develops as a system, and this systemic development constitutes the essence of human development.

He understands that a brief theoretical reflection on the psychological nature of the meaning of the word is necessary, and he asserts that consciousness is reflected in the word and various meanings emerge from it, being converted into personal senses according to the needs and emotions that motivated its use, that is, the meaning of the word holds the properties of consciousness. The personal senses addressed here refer to the sum of all psychological events that the word awakens in consciousness (Vygotsky, 1987).

Another relevant consideration made by Vygotsky refers to the main and primary function of speech: communication. For him, speech is a means of social interaction, expression, and communication (Vygotsky, 1987). Speech combines the function of social interaction and the function of thought, differently from what was advocated by traditional Psychology. For Vygotsky, social interaction is based on rational understanding, on the intentional transmission of experience, and requires a system of forms, which would be human speech, manifested through the word. The subject in Vygotsky establishes relationships with and in the experience of other subjects through intersubjectivity. Thereby, the word, endowed with meaning, while simultaneously awakening events in consciousness, is the basis for its formation. Consciousness has a social origin, as the reversible reflexes originated from the word serve as the foundation for social communication and for the collective coordination of behaviour (Carvalho; Araújo; Ximenes; Pascual, 2010).

Another aspect pointed out by Vygotsky is that when considering the relationship between thought and speech and other aspects of the life of consciousness, we should have to take into account the connection between intellect and affect. This would be another problem of traditional psychology pointed out by Vygotsky by isolating the intellectual part from the volitional and affective aspects of consciousness. He highlights the relevance of considering the affective aspects of thought, and if these are not taken into account, it is as if we have nullified thought. Action and thought are motivated, they are triggered by stable emotional values, which are configured by the connection between psychological processes, external relationships, and the organism. Thus, feeling, thought, and will are related, meaning there is no isolated functioning among them, but functional interconnections (Vygotsky, 1987).

Finally, Vygotsky affirms that the unit of analysis of human behaviour that can include all psychological manifestations would be the sign. He argues that consciousness is constituted by signs, which are instrumental stimuli of a social nature that shape the human being through social interaction. The signs would act upon the subject and be closely related to their capacity for creation and imagination, which, in turn, would manifest equally in all aspects of cultural life. He understands consciousness from a historical-cultural perspective with i) a function of social origin that takes into account contact with other individuals - social interaction; ii) weaving relationships with the sense and meaning of the word; iii) considering affectivity and emotion; iv) conjecturing that it is constituted by signs.

Vygotsky’s perspective on the interrelation between the interpsychological and intrapsychological planes, and his formulation of consciousness as a system, provided him with important conceptual and analytical tools to investigate the depths of human consciousness. For him, communication was the foundation of internal consciousness through internalisation (Leont’ev, 1997; Lindqvist, 1995) and consciousness presupposed communication between at least two voices-one’s own voice and the voice of the other.

1.2 Conceptualising Consciousness: Vološinov’s Perspective

Similar to Vygotsky, who frequently criticised Scientific Psychology⁷ for attempting to explain thought purely in terms of thought and behaviour solely through behaviour, relying mainly on biological sciences, Vološinov also understood that form and meaning must originate from something else to develop in tandem. “For Vološinov, that ‘something else’ was exactly the same explanatory principle that Vygotsky had seized upon. That is, it is found outside the individual rather than merely within; it is not abstractly objective but concrete and tangible” (Kellogg, 2009, p. 85) and, in this way, it would be an inseparable part of the language we use in our daily lives: human communication, carried out through words.

In Marxism and the Philosophy of Language, Vološinov (1973) conceives the idea of consciousness, introducing the problem of the ideological sign, which is not merely a reflection or a shadow of reality; in fact, it is a material part of that very reality. It both reflects and refracts this reality. Signs exist concretely in the world and have real effects - meaning that all the actions, reactions, and new signs they provoke in the social environment are part of their influence. Ideological signs are not only present within individuals’ minds; they interact with the external world and shape social reality, functioning as active forces that both mould and are moulded by social and material realities.

For Vološinov, consciousness extends beyond just what we are consciously aware of or perceive. Instead, he views consciousness as encompassing the entire psyche, including all mental processes, whether conscious or unconscious. And mental processes are mediated by ideological signs that we use to make sense of the world. Furthermore, he argues that while the physical form of signs may change, their referential content, or the meaning that the sign carries, remains unchanged during this transition.

The chain of meanings remains intact as the sign moves from the external world to consciousness and vice versa. This ability of signs to change form without losing their meaning is something Vološinov considers significant and worthy of deeper reflection. He suggests that we should focus on the processes by which signs are created, as these processes are crucial for understanding how consciousness functions and how meanings are constructed and transformed (Leiman, 2011). Therefore, Vološinov points out that (1973) individual consciousness is fundamentally a social and ideological fact.

Vološinov cites that the “Science of Ideologies” is central to the study of consciousness and Psychology is based on it. Consciousness is permeated by ideological signs and can only be considered when there is ideological communication, which occurs through the word, which is an ideological phenomenon par excellence. Therefore, the word mediates social communication, that is, the semiotic and ideological consciousnesses. Moreover, it is considered a neutral sign, as it can assume any ideological function: scientific, aesthetic, moral, religious; it is the most usual material of everyday communication and has become the semiotic material of inner life: consciousness (inner speech) (Vološinov, 1973).

For Vološinov (1976),⁸ an intelligible communication is the expression and product of the social interaction of three participants: the speaker (author), the listener (reader) and the topic (the who or what) of speech (the hero). Thus, he introduces a third dimension of consciousness, which he describes as “social consciousness” or “social soul,” reflecting how individuals think, feel, and perceive within a social context. Analysing language cannot be confined to the abstract perspectives of formal linguistics or psychology alone, as these approaches are insufficient to capture the essence of discourse on their own. Real language, or the “concrete utterance,” is born, lives, and dies within the process of social interaction and is profoundly influenced by the consciousness of the participants. Thus, the form and meaning of any verbal expression are shaped by social interaction and the consciousness of the individuals involved. To fully understand language, it is crucial to consider how individual and collective consciousness interact within the social context. Therefore, Vološinov ‘s perspective on consciousness refers to the notion of language ‘refracting’ an extra-discursive reality.

1.3 Conceptualising Consciousness: Bakhtin’s Perspective on the Novel and Its Contributions to Contemporary Mental Health

Like Vygotsky and Vološinov, Bakhtin understood that consciousness is inseparable from social communication and was composed of utterances,⁹ considering them to be “the real unit of speech communication.” Once linguistics does not study utterances as such, but only the sign within a synchronic system, Bakhtin proposed ‘translinguistics’ or ‘metalinguistics,’¹⁰ which is “the study of those aspects in the life of the word, not yet shaped into separate and specific disciplines, that exceed - and completely legitimately - the boundaries of linguistics” (Werstch, 1991, p. 181).

Bakhtin’s writings on the idea of consciousness were developed in dialogue with Vološinov ‘s works, but Bakhtin did so by writing essays on the novel.¹¹ Thus, the “dialogical variety”¹² of the novelistic genre was influenced by a number of oral/folkloric sources as well, then the fabliaux and swanke, but Bakhtin ([1963] 1984a)¹³ specifies two literary genres of the serious-comic field - the Socratic dialogue and the Menippean satire or Menippea.¹⁴ Bakhtin points out that these were precursors of the dialogical style of Fyodor Dostoevsky and François Rabelais, in which characters and ideas clash in a profound dialogue, without a single perspective prevailing.

In his analysis of pre-novelistic and novelistic forms, Bakhtin explores questions that today would be regarded as ones of ‘mental health’ issue, such as the exploration of unusual psychological and moral states like different forms of madness, split personalities, uncontrolled daydreams, extraordinary dreams, and passions that verge on insanity. Although these manifestations are still embryonic, they reveal a new perception of the human being, highlighting their imperfection and internal division. The Menippea also stands out for scenes of scandal, eccentric behaviours, and inappropriate statements, breaking with the behavioural and discursive norms accepted by society (Bakhtin, 1984a).

Moreover, the Menippean satire became the main vehicle and bearer of the carnivalesque¹⁵ worldview, which encompasses characteristics such as eccentricity, which refers to the violation of what is common and generally accepted in society, and life displaced from its usual course. (Bakhtin, 1984a, p. 123) Through this genre, the dialogical consciousness in Bakhtin was depicted in his essays on novels and materialised through the characters. In this way, we will briefly observe how he approaches this in the works of Dostoevsky (Bakhtin, 1984a)¹⁶ and Rabelais (Bakhtin, 1984b) and the possible contributions to think about mental health issues today.

1.3.1 Dostoevsky’s Work

In Problems of Dostoevsky’s Poetics (Bakhtin, 1984a, p. 13), Bakhtin begins by addressing the issue of the characters, based on the idea that this “[...] freedom and independence characters possess, in the very structure of the novel, vis-a-vis the author - or, more accurately, their freedom vis-a-vis the usual externalising and finalising authorial definitions.” Thus, these heroes are free and possess a critical outlook, taking a stance on the events around them.

The concept of polyphonic novel proposed by Bakhtin arises and it is related to the conception of dialogical consciousness, when he points to this multiplicity of voices,¹⁷ this plurivocality, which comprises the consciousness of the author and the hero, these being distinct and independent, but at the same time coexist and interact, with none overriding the other, that is, there is no dominant consciousness, there is no dominant discourse.

Consciousness is formed in constant interaction with other voices, with other consciousnesses. And this multiplicity of voices in the novel reflects the complexity and fragmented nature of individual consciousness itself, as well as reflecting the complexity of human experience, since different consciousnesses, voices, and perspectives are in constant interaction. Human consciousness as modelled in Dostoevsky’s novel is dialogical and plural. And this dialogical consciousness, permeated by different voices without highlighting only one in dialogical interactions, is one of the main characteristics of Dostoevsky’s novel and what differentiated it from other works of the time.

Bakhtin understood that the character’s consciousness of reality in Dostoevsky,¹⁸ as well as the external world surrounding him and the customs, since these are integrated into the process of self-awareness and are rational and evaluative positions of man in relation to himself, as well as the reality in which he is immersed. Therefore, “those elements out of which the hero’s image is composed are not features of reality-features of the hero himself or of his everyday surroundings-but rather the significance of these features for the hero himself, for his self-consciousness.” (Bakhtin, 1984a, p. 48, author’s emphasis) Dostoevsky reflects and refracts the hero’s consciousnesses in social interaction, portraying the crises and twists of life, lives on the edge. According to him, the truth about the world is inseparable from the truth of the individual. He managed to identify dialogical relationships everywhere, in all manifestations of conscious and rational human life.

In addition, the emphasis in his works is placed on both the aspect of form and content, being “struggle against a reification of man, of human relations, of all human values under the conditions of capitalism.” However, Dostoevsky never used the term ‘reification’, but he “was able to see how this reifying devaluation of man had permeated into all the pores of contemporary life, and even into the very foundations of human thinking” (Bakhtin, 1984a, p. 62). Dostoevsky perceived the devaluation of human values in capitalism as a growing trend that ended up influencing society and the thoughts of the time.

Generally, in his novels, Dostoevsky explores themes of madness, alienation, and the complexity of human nature, and through the ‘man from underground,’ he portrays the conflict between individuality and social conformity, questioning what it means to be human in a world marked by contradictions and moral tensions, characterised by a deep and questioning consciousness. In this way, the narrator serves as a vehicle that expresses these concerns, reflecting the internal struggle between reason and madness, normal and abnormal, and the individual and society, since, according to Bakhtin’s ideas (1984a, p. 147; author’s emphasis), “In Dostoevsky, the participants in the act stand on the threshold (on the threshold of life and death, falsehood and truth, sanity and insanity).”

In The Dream of a Ridiculous Man, for instance, considered almost a complete encyclopaedia of Dostoevsky’s major themes,¹⁹ the “ridiculous man” is depicted through the “ambivalent serio-comic image of the ‘wise fool’ and the ‘tragic fool’ of carnivalized literature” (Bakhtin 1984a, p. 168). This portrayal demonstrates that Dostoevsky did not conceive of human value as monotonous; rather, he saw human nature as complex, multifaceted, and rich in nuances and values, which emerge from the dynamic interactions between individuals, between different consciousnesses. Based on these ideas, Bakhtin asserts that the story begins with the most typical theme of the menippea: the man as the sole bearer of truth, and therefore ridiculed by others as a madman and it is shown the central concerns in Dostoevsky’s works: the complexity of the human condition and the search for meaning in a world that is often indifferent.

To sum it up, in Dostoevsky, the dialogic consciousnesses of the characters reflect interactions between different voices and values, experiencing internal conflicts and moral dilemmas. His characters are often immersed in psychological suffering, grappling with issues of alienation, guilt, and identity.

1.3.2 Rabelais’ Work

Rabelais’ work addresses the diversity of human experience and the complexity of society by bringing dialogues between characters with different worldviews in spaces where multiple voices²⁰ can coexist and dialogue - an encounter of different consciousnesses. Bakhtin’s concept of consciousness is one that is never isolated but formed through dialogue with other voices and societal factors. Utterances are reflections of this dynamic interplay; they are not merely expressions of individual thought but are informed by the consciousness of others and the sociocultural conditions surrounding the speaker. Consciousness is always interwoven with the historical, social and cultural forces that influence how we understand and express meaning (Bakhtin, 2011).

The characters’ speeches in Rabelais reflect this dynamic interaction, where individual thought is shaped by the voices of others and by the sociocultural factors surrounding the speaker. This is directly connected to the carnivalesque worldview embedded in the work, as it is characterised by a celebration of freedom, subversion, and the transgression of social norms, allowing for the temporary suspension of social hierarchies and norms (Bakhtin, 1984b). Thus, there is a humorous social critique and a questioning of the rigidity of the conventions of the time.

The stock characters of literature were clowns and fools²¹ (typical figures of carnival), considered permanent and consecrated vehicles of the carnivalesque principle of everyday life (the one that unfolds outside of carnival) (Bakhtin, 1984b). And in Rabelais’ novelistic world, they relate to forms of archaic and folkloric culture. Furthermore, they attended civil ceremonies and everyday life rituals and parodied them, offering a worldview, a view of man, and of relationships that was completely different from the “official perspective.” Such characters were not actors; they did not merely play the roles of clowns and fools during comic events but lived this situation full-time.

The king’s fools played a highly relevant role: beyond mere comedy and entertainment, they were the only ones who could utter the “cruellest” truths to the king - truths that few would have the courage to say - because they wore the mask of madness,²² which became an extremely unstable category. Additionally, they performed a political role, advising the king and mocking other powers, such as the Church and the nobility, while always being protected by the “foolishness” they represented. However, these characters were free, considering the context²³ in which they existed, and through humour, they offered criticism and denounced certain abuses of the ruling system. And the clown uses laughter to bring down what is considered elevated or spiritual, questioning and challenging the social and cultural norms of the Middle Ages, grounding everything in the body and material life - what Bakhtin (1984b) terms grotesque realism.²⁴ This parody of the official world serves as a critique of established hierarchies, celebrating the human body and its vitality as forms of resistance and freedom in the face of dominant cultural conventions.

Brandist (2002) explains that Bakhtin interprets the grotesque body as a metaphor for universal dialectics, reflecting the continuous movement of the spirit in its quest for self-overcoming. This body is not limited to the individual or biological realm but symbolises the collective human body - the body of the people - that moves away from a purely natural state and rises toward a more independent and conscious existence. Its finest expression in literature is found in Rabelais’ work, where the grotesque body represents the collectivity and vitality of humanity. In Rabelais’ novel, the dialogic consciousnesses of the characters are connected to collective experience and the body, besides it is also rooted in collective cultural forms such as folklore. His caricatured characters reflect a carnivalesque worldview, where the grotesque and the fool challenge social norms and celebrate the diversity of human experience.

Therefore, Vygotsky, Vološinov and Bakhtin ideas on consciousness converge in the comprehension that language is a social phenomenon and constitutes consciousness, although they present different emphases, since i) Vygotsky highlights mediation through signs and social interaction as fundamental for cognitive development, and consciousness is formed from this socially mediated cognitive development; ii) Vološinov points out that consciousness is social and ideological, formed by ideological signs that reflect and refract reality; and iii) Bakhtin is in accordance with Vološinov ‘s ideas, but his approach is based on the analysis of novels. For him, consciousness is inseparable from social communication and is polyphonic, permeated by countless voices, ideas and values.

Moreover, Bakhtin talks about ‘madness’ or extreme mental states in literature and it can help us to consider and to reflect mental health in our contemporary society, considering the following factors: i) the importance to ensure discussions on mental distress not be limited only to biological factors and, consequently, hiding some problems that are not interesting to be shown; ii) to take into account that the subject - in our case, who is under a mental distress - is always constituted in a continuous dialogue with other voices and social experiences; iii) to consider the “body of the people” as an active agent in this process, challenging social and political norms through collective expressions, where collective experience becomes a powerful form of resistance and social transformation; iv) to reflect on the ideas present in society, the dominant and the emerging voices, the weak voices, those on the margins and also gives voice to these subjects who have a mental distress; and v) to question what it means to be human in a world marked by contradictions and moral tensions, characterised by a deep and questioning consciousness.

2 Decolonising Mental Distress through a Dialogical Perspective

Let us say that there is a human being before me who is suffering. The horizon of his consciousness is filled by the circumstance which makes him suffer and by the objects which he sees before him. The emotional and volitional tones which pervade this visible world of objects are tones of suffering (Bakhtin, 1990, p. 25).

When Bakhtin (1990) states this, we understand that this consciousness is not just a psychological phenomenon, but also an ideological phenomenon, being a product of social exchange (Vološinov, 1976). In this way, this subject ends up assuming an active social position in relation to specific values and this position is conditioned by the very foundations of his social existence.

Considering the aspects of consciousness - approached by Vygotsky, Vološinov and Bakhtin -, a complex system directly linked to reality, which is social and ideological and considering that social interaction between individual consciousnesses is laden with ideological signs, mental distress would be represented by a consciousness permeated by ideological signs laden with negative values and feelings, through exchanges between individual consciousnesses as well as social aspects. The experiences that surround us are converted into ideological signs, which in turn are used to establish relationships with the environment and with other interlocutors. When addressing a distress in this complex system, which is human consciousness, we should not reduce such an approach to organic functioning or non-functioning.

This discussion converges with Basaglia’s critique of the biomedical model, as his conception of Democratic Psychiatry raised one of the central questions in the mental health debate: is mental distress truly an illness, or rather an expression of deeply rooted ideological and social conflicts? Basaglia, Lovell and Sheper-Hughes (1987, p. 8) affirm that

[it] was Basaglia’s bracketing²⁵ of mental illness as disease that provided ammnunition to the critics who for many years falsely accused Basaglia of denying the existence of mental illness. Basaglia meant only to imply that we could not know what was the reality of the illness until we could first strip away the many layers created by poverty, stigma, segregation, and confinement which covered and concealed it.

Thus, Basaglia highlighted the multiple factors that obscure the true nature of mental distress. Fried (2022), through contemporary studies, points out that researches related to mental distresses are reductionist and that mental health problems should be addressed as systems, since the state in which our consciousnesses are found is the result of interactions “of numerous biological, psychological, and social features, including specific risk and protective factors, moods, thoughts, behaviours, biological predispositions, and social environments” (Borsboom, 2017; Fried et al., 2022; Kendler et al., 2011; Olthof et al., 2021; Robinaugh et al., 2020 apud Fried, 2022, p. 504).

As well as depicted in Rabelais’ work, it is needed to consider the diversity of human experience and the complexity of society, taking into account the interactions between people with different worldviews in spaces where multiple consciousnesses can encounter each other. In Dostoevsky, the meaning attributed to the hero himself, to his self-consciousness is the most important to feature his reality. Therefore, today, if these voices will really be heard, the distressed consciousnesses can be better understood, and consequently, possible solutions can be found to solve this issue and to provide a more dignified life to the subjects that are suffering, which frequently are mocked and stereotyped as mad by the “normal” subjects. In fact, we need to recognize that we differ from each other and we also need not to be indifferent to these subjects that are suffering, but make their voices being heard to comprehend better the problems that are hidden in their distresses.

However, in the works of Rabelais and Dostoevsky, the fool or the madman has an important role in the society, criticising and denouncing abuses of the ruling system. They are also free to do it. Nowadays, the “madman” - this is how a mental distress subject is generally called - is not heard; these people do not have a voice, their consciousnesses are not considered to be important, they are not free. Although there are many improvements in the mental health area, especially with the end of the asylum-based model and the inclusion of the mental distress subjects in society, they still remain at the margins - excluded, in silence and unheard.

In contrast to this “contemporary” silencing of mental distress subjects, the need to listen to different forms of consciousness - especially those considered deviant or “mad” - finds concrete expression in Basaglia’s proposals. He held assembleas²⁶ with psychiatric hospital patients, creating a horizontal space for listening, where individuals in psychological suffering could share their experiences, pains, and criticisms of the system that oppressed them. In doing so, Basaglia not only acknowledged the importance of these marginalized consciousnesses, but also worked to restore them to the public sphere, reaffirming their political and existential value. Foot (1964, p. 148) notes that

Previous rigid hierarchies were flouted, overturned, ignored and undermined. The assemblea was the practical demonstration of Basaglia’s claim to have placed mental illness ‘in brackets’ when dealing with patients. During these encounters, some patients would cause trouble, and it was difficult to concentrate on the matter in hand, and often frustrating. But Basaglia saw patient disturbances as part of the process of change, as signs of (welcome) rebellion. His work, he claimed, was intended to open up contradictions in the system. A community was being formed, which would be able, in time, to act in a collective way.

Basaglia’s approach, as described by Foot (1964), reveals the potential of collective spaces to destabilize institutional hierarchies and to question the very foundations of psychiatric power. The assembleas were not merely a therapeutic tool, but a political act that exposed the system’s contradictions and allowed the emergence of community agency. From this perspective, Basaglia’s experience resonates with the spirit found in the works of Dostoevsky and Rabelais, as interpreted by Bakhtin: a polyphonic world, where multiple voices, often dissonant, coexist and challenge centralized authority. These assembleas, in Bakhtinian terms, were arenas of dialogic truth - not fixed, but emerging from the tension among voices.

Among the contemporary spaces that resemble Basaglian assembleas - in which mental distress subjects can express themselves and can be heard - the Centros de Atenção Psicossocial [Psychosocial Care Centers] (CAPS) in Brazil stand out. These services were established within communities aiming to promote deinstitutionalization and provide care based on the needs and singularities of individuals, supported by a territorial and interdisciplinary logic (Delgado, 2019). Thus, individuals who previously occupied passive roles in the face of interventions began to be the protagonists over their own life trajectories, expanding their presence in urban spaces and strengthening the exercise of social participation (Amarante; Torre, 2017).

Although such mental health services represent significant institutional advances, the changes were not sufficient to consolidate a definitive break with the traditional psychiatric model (Alverga; Dimenstein, 2006). Thus, the CAPS began to incorporate, simultaneously, both conventional biomedical practices and innovative, emancipatory approaches in the field of mental health (Lima; Gonçalves, 2020 apudSampaio; Bispo Júnior, 2021). However, some of the issues in which these new spaces for the treatment of mental distress subjects failed to advance were the social stigmatization of them and the problem of hypermedicalization (Lima, 2018 apud Sampaio; Bispo Júnior, 2021).

Such limitations, nevertheless, cannot be understood in isolation, as they are part of a broader context in which neoliberal capitalism has increasingly led to the medicalisation and commodification of various aspects of human emotions and behaviours, turning them into profitable ventures for the health and pharmaceutical industries (Fisher, 2009; Davies, 2017). This shift has ideological implications, as it redefines social issues as individual pathologies, diverting attention from the structural inequalities and injustices that further complicate people’s lives (Fisher, 2009; Davies, 2011; Cohen, 2016). Thus, we understand that despite the biomedical ideology or “psychiatrization” being the dominant mode, there are numerous discussions behind it that actually conceal numerous political, economic, and social problems, as well as camouflage the numerous gaps and deficiencies in policies that address this issue. James Davies (2022, pp. 2-3) affirms that

We blame suffering on faulty minds and brains rather than on harmful social, political and work environments. We promote highly profitable drug interventions, which, if great news for big pharmaceutical corporations, are in the long term holding millions of people back. […] While each industry offers its own profitable elixir for emotional success, they all share and promote the same consumerist philosophy of suffering: your central problem is not that you’ve been mis-taught how to understand and engage with your difficulties (your ageing, your trauma, your sadness, your anxiety or grief), but the fact that you experience suffering at all - something that targeted consumption can address. Suffering is the new bad, and failing to consume the right ‘remedies’ is the new injustice.

Capitalism is devaluing human beings, treating them as objects. And it is not different when we are treating individuals who are suffering from mental distress. Concerns, anguish, and misery, when framed as medical conditions, isolate individuals as patients who need to be cured of their internal deficiencies, which diminishes the understanding of the social implications of these emotions. This medicalisation prevents society from recognizing the epidemic of mental health issues as “comments on social life” (Davies, 2017, p. 205). Thus, mental health problems are outcomes of specific socioeconomic conditions inherent in recent capitalism, as well as the ways these conditions are interpreted. Additionally, it is important to consider that some aspects of human life are enduring and manifest across different types of societies with varying economic structures. (Davies (2011), Cohen (2016), Davies (2017), Moncrieff (2022)).

From a decolonial perspective, this critique underscores how the neoliberal paradigm reinforces colonial patterns of thought that individualise and medicalise suffering, diverting attention from the systemic and structural conditions that contribute to people’s distress. This framework reflects a broader colonial tendency to impose Western²⁷ solutions and ideologies on diverse populations, overlooking the rich, context-specific understandings of suffering and healing. Therefore, the profitable drug interventions and consumerist solutions for emotional well-being not only benefits pharmaceutical corporations but also perpetuates a cycle where the root causes of suffering - such as inequality and systemic injustice - are ignored.

Thus, stemming from this critique of medicalisation and its entanglement with capitalist structures, it becomes essential to explore alternative frameworks for mental health care. In this regard, the ideas of Basaglia and the concepts developed by the early Soviet authors - especially Bakhtin - can contribute to the construction of a theoretical-political space that values care as encounter, listening, and collective meaning-making. From this perspective, we could consider one of the forms of mental health care that escapes the medicalising logic to be those care practices that emerge from the communities themselves, as part of a movement that combines epistemological critique and social transformation.

This approach is closely aligned with decolonial proposals, which denounce the coloniality of knowledge and the universal model imposition of subjectivity and care, thereby overcoming the structures of power. By recognizing that mental distress is rooted in histories of exclusion, silencing, and structural violence, a dialogical and social approach to subjectivity contributes to the construction of alternative epistemologies and practices - those that escape biomedical dominance and value local and popular knowledge. Furthermore, it gives voice to and positions mental distress individuals as true social actors, rather than mere passive recipients.

In this sense, the decolonial horizon is not limited to a theoretical critique, but points to the concrete possibility of reorganizing care based on listening, community participation, and the shared production of meaning through: (i) the valorization of the knowledge held by the subjects; (ii) the provision of opportunities for involvement and collective participation, rather than focusing on individualized and imposed practices; (iii) the construction of “listening spaces” within the community itself, which foster personal empowerment - spaces that can be created and managed by mental distress subjects; (iv) the recognition of mental distress as rooted in social conditions; (v) the inclusion of critical, decolonial, and dialogical epistemologies in the training of professionals who will work and deal with these subjects; and (vi) struggles against the setbacks inherent in mental health services.

We understand, then, that such strategies constitute decolonial practices from a dialogical perspective, based on the discussions developed thus far regarding the concept of consciousness through the ideas of Vygotsky, Vološinov, and Bakhtin; as well as Bakhtin’s perspectives on the novel - especially his readings of both Dostoevsky and Rabelais - and their dialogue with Basaglia’s anti-asylum proposal, through Democratic Psychiatry. In this way, it becomes possible to understand mental suffering not as a pathological given to be corrected, but as a multiple, social, and situated expression of human experience. Rabelais’ parody depicts the official world serves as a critique of established hierarchies, celebrating the human body and its vitality as forms of resistance and freedom in the face of dominant cultural conventions, and this helps us to think mental distress in a decolonial way.

Thus, reflecting on mental distress through the lens of these authors also means proposing counter-hegemonic practices that break with medicalisation and restore the subject’s potential in all its complexity. Instead of silencing the meanings of suffering through diagnostic labels, the aim is to create spaces where different voices can be expressed, where the body, language, and lived experience are taken seriously. It is relevant to discuss mental distress from a perspective that values freedom of expression, joy, and the acceptance of the multiple facets of existence, rather than conforming to rigid standards of behaviour or thought.

And it is also important to recognize the complexity of human suffering and the significance of dialogue and empathy in the pursuit of well-being. And, we agree with Cohen (2016, p. 11) when he states that “it should be the duty of all social scientists concerned with the mental health field that, […] they remain highly sceptical of a psychiatric discourse that poses as expert knowledge on the mind but produces little actual evidence to back up the assertions made.”

Final Considerations

The objective of this article was to weave dialogical reflections on the ideas of consciousness through Vygotsky, Vološinov and Bakhtin dialogical perspectives, and from it, make decolonial reflections on mental distress. Firstly, from their perspectives on consciousness, it becomes clear that understanding mental distress is intrinsically linked to social interactions and cultural contexts, once consciousness and human experience are shaped by dialogic and interactive processes, rather than solely by isolated biological or psychological factors.

Secondly, the treatment of suffering should not be confined to individualised and commodified interventions, which often disregard the impact of social and economic conditions. Mental distress approach shows limitations, under a neoliberal lens, once it treats social and emotional issues as pathological and individual, marginalising and devaluing cultural and collective approaches to understanding and addressing suffering.

In order to address and remediate social and emotional problems effectively, an approach that goes beyond medicalisation and neoliberal logic is required. It is essential to adopt a framework that integrates the social, cultural, and structural dimensions of suffering, promoting solutions that are both equitable and deeply rooted in the realities and contexts of affected individuals and communities. By doing so, we can build a more holistic and just understanding of human suffering and seek more effective and humane ways to approach it.

Considering this, we need to question and transform such hegemonic models - the biomedical ones - that shape the way we understand mental distress, since we end up individualizing suffering and neglecting social, historical, and cultural causes. In addition, we need to relocate mental distress in the socio-political and cultural context, also understanding it as an extension of our society and the structural violence we suffer, such as poverty, wars, exclusion, among others.

Therefore, Vygotsky, Vološinov and Bakhtin ideas on consciousness are important regarding the comprehension of mental distress from a new perspective - social and ideological ones, and not only biological, making it possible to rethink approaches to mental health care beyond the limits imposed by medicalisation and the centrality of the hegemonic psychiatric discourse. This dialogical understanding of consciousness allows for a critical reflection aimed at destabilizing the individualizing foundations of traditional psychiatry and opening space for the plurality of experiences of mental suffering.

Moreover, through the novels, Bakhtin makes us see that we must give voice to the subjects who are on the margins, the excluded ones and the subalterns and, from this, we can understand the society in which we are inserted and, consequently, the problems that plague us. This perspective aligns with decolonial proposals, which denounce the coloniality of knowledge and the imposition of universal models of subjectivity and care.

By highlighting the importance of listening, dialogue, and the recognition of silenced voices, the ideas of Vygotsky, Vološinov, and Bakhtin directly resonate with concrete experiences of transformation in mental health care, such as those promoted by Franco Basaglia in Italy. Basaglia broke with the asylum-based logic and proposed community-based practices centered on dignity, freedom, and the participation of individuals, recognizing mental distress as a matter shaped by social and historical determinants. Thus, by rethinking consciousness as a dialogical and socially situated phenomenon, we pave the way for practices that demedicalise suffering, decentralize technical knowledge, and promote fairer, more plural forms of care rooted in lived experiences and local territories.

Acknowledgment

We would like to thank CAPES (Coordination for the Improvement of Higher Education Personnel), since the researcher received funding to carry out the Sandwich Doctorate at the University of Sheffield, in England.

• Research Data and Other Materials Availability
  The contents underlying the research text are included in the manuscript.
• Reviews
  Due to the commitment assumed by Bakhtiniana. Revista de Estudos do Discurso [Bakhtiniana. Journal of Discourse Studies] to Open Science, this journal only publishes reviews that have been authorized by all involved.
• 1
  This article was written under the supervision of Professor Dr. Craig Brandist, during my Sandwich Doctorate in The University of Sheffield, in England.
• 2
  This theoretical model was used to analyse the most varied phenomena, such as: authoritarianism as a political formation, as well as how it manifests itself both in the nuclear family and in deeply rooted psychological dispositions; and the effects of capitalism on psychological, social, cultural and political formations, as well as on the production of knowledge itself (Thompson, 2017; Gordon, Hammer, Honneth, 2019; Celikates, Flynn, 2023).
• 3
  Fredric Jameson (1984) understands the conception of modernity from a historical perspective, and not just a stylistic one. In other words, modernity is the dominant cultural aspect of the logic of capitalism, and not only as a style (optional) among many others available.
• 4
  In this work, we are going to use this term instead of mental illness, mental disease or mental disorder. These are all ideologically charged, and tend towards pathologising the individual and we do not consider mental distress a disease, once it does not have an organic cause. Ferguson (2017) also uses this term and argues that mental distress is a result of social interactions and experiences, and that the current economic and political system, capitalism, contributes to high levels of it.
• 5
  In terms of the “crisis of psychology,” the influence of the studies of Karl Bühler (1927) on the writings of Vološinov and Vygotsky on this theme must be taken into account. A year before the book “The Crisis of Psychology” (Bühler, 1927) was published, but an article with the central problematic of his work was published and may have been read by both Vygotsky and Vološinov, influencing the works “The historical meaning of the crisis in psychology: a methodological investigation” (Vygotsky, 1927) and “Freudianism: A Critical Sketch” (Vološinov, 1927) (Brandist, 2004).
• 6
  It is defined as psychotechnics, applied psychology and it provided “the crucial intellectual and institutional context within which Vygotsky’s ideas developed.” (Brandist, 2007, p. 81) In fact, psikhotekhnika had brought the discipline to the point of crisis.
• 7
  A type of Psychology based narrowly on the natural sciences.
• 8
  Based on Karl Buhler’s ideas.
• 9
  For Bakhtin, the definition of utterance is directly linked to the notion of voice, which refers to “the speaking personality, the speaking consciousness” (Bakhtin, 1981, p. 434). Therefore, utterances are expressed through voice, or this speaking consciousness, which exists only in a social environment and not in isolation. Moreover, there can’t be consciousness without consciousness.
• 10
  Bakhtin adopted this term in the 1960s. Mika Lähteenmäki (2003) has written well about this.
• 11
  Brandist (1996, p. 2) affirms that “Bakhtin, at least in his mature work, concentrated on the dynamics of western popular culture and literature in an attempt to highlight certain features of the contemporary Soviet cultural life.”
• 12
  It would be a type of narrative in which different voices and points of view dialogue and oppose each other.
• 13
  In the 1963 edition of the Dostoevsky’s book, Bakhtin specifies the two genres mentioned: the Socratic dialogue and the Menippean satire or Menippea.
• 14
  The novelistic genre was influenced by two literary genres in the serious-comic field: i) the Socratic dialogue, which consists of a philosophical debate where several opinions are confronted to arrive at the truth. This “did not exist for long, but in the process of its disintegration other dialogic genres were formed, including Menippean satire” (Bakhtin, 1984, p. 112); and ii) the Menippean satire, a genre that ridicules institutions and ideas established in an ironic way. However, this “cannot of course be considered a pure product of the decomposition of the Socratic dialogue (as is sometimes done), since its roots reach directly back into carnivalized folklore, whose decisive influence is here even more significant than it is in the Socratic dialogue” (Bakhtin, 1984a, p. 112).
• 15
  The carnival aspects of Dostoevsky’s work were introduced only in the 1963 edition, after the Rabelais dissertation. It is not certain it really fits easily into the otherwise little changed study of 1929.
• 16
  According to Bakhtin, the menippea plays a crucial role throughout Dostoevsky’s work, with the characteristics of this genre and other related forms being broadly applicable to the structure of the author’s texts. He further asserts that, although not exhaustive, the study of generic influences in Dostoevsky’s work suggests that the writer had access to, or at least could have been familiar with, various forms of the menippea. This genre is flexible and full of potential, particularly suited for exploring the deeper aspects of the human soul and for presenting fundamental philosophical issues in a sharp and clear manner.
• 17
  This is one of the most important features pointed out by Bakhtin in Dostoevsky’s novels, as well as the fullness of each voice. And Lunacharsky mentions that all the voices playing a significant role in the novel are convictions or viewpoints about the world.
• 18
  Bakhtin distinguishes between reality as such and consciousness of it - this is a central philosophical question, and one that, in our evaluation, renders Bakhtin an idealist.
• 19
  All the themes, as well as the very method of their artistic elaboration, are characteristic of the carnivalized genre of the menippea (Bakhtin, 1984a).
• 20
  In a significant analysis of Rabelais’s perspective, Michelet states that he “[...] collected wisdom from the popular elemental forces of the ancient Provencal idioms, sayings, proverbs, school farces, from the mouth of fools and clowns” (Bakhtin, 1984b, p. 2).
• 21
  It is worth noting that these were stock characters but they take on specific forms in certain times and the works of certain authors.
• 22
  In the Middle Ages, madness held a different meaning from that in our current society, as it possessed a magical and wise character (Foucault, 1965).
• 23
  Mediaeval period under the strict rules of the feudal and ecclesiastical system.
• 24
  In the 1940 dissertation, the term is gothic realism.
• 25
  This term was “Essential to Basaglia’s analysis of psychiatric situations” and it was based on “Husserl’s concept of “bracketing” or “epoché:” the suspension of judgments in the first encounter with the reality of the immediately given” (Basaglia; Lovell; Sheper-Hughes, 1987, p. 8).
• 26
  Assembleas are spontaneous general meetings.
• 27
  In fact, the Capitalism imposed corporate/medical approaches, firstly, in the Western.

References

• ALVERGA, Alex R. D.; DIMENSTEIN, Magda. A reforma psiquiátrica e os desafios na desinstitucionalização da loucura. Interface: Comunicação, Saúde, Educação, Botucatu, v. 10, n. 20, pp. 299-316, 2006.
• AMARANTE, Paulo; TORRE, Eduardo H. G. Loucura e diversidade cultural: inovação e ruptura nas experiências de arte e cultura da Reforma Psiquiátrica e do campo da Saúde Mental no Brasil. Interface: Comunicação, Saúde, Educação, Botucatu, v. 21, n. 63, pp. 763-774, 2017.
• BAKHTIN, Mikhail. Discouse in the Novel. In: BAKHTIN, Mikhail. The Dialogic Imagination: Four Essays. Edited by Michael Holquist. Translated by Caryl Emerson and Michael Holquist. Austin: University of Texas Press, 1981. pp. 259-422.
• BAKHTIN, Mikhail. Art and Answerability: Early Philosophical Essays. Translated by Kenneth Brostrom. Edited by Michael Holquist and Vadim Liapunov. Austin, TX: University of Texas Press, 1990.
• BAKHTIN, Mikhail. Estética da criação verbal. Russian translation by Paulo Bezerra. São Paulo: Martins Fontes, 2011. [1979]
• BAKHTIN, Mikhail. Problems of Dostoevsky’s Poetics. Edited and translated by Caryl Emerson. Introduction by Wayne C. Booth. Minneapolis, MN: University of Minnesota Press, 1984a. [1963]
• BAKHTIN, Mikhail. Rabelais and His World. Translated by Helene Iswolsky. Bloomington, IN: Indiana University Press, 1984b. [1965]
• BAKHURST, David. Vygotsky’s Demons. In: DANIELS, Harry; COLE, Michael; WERTSCH, James. (eds.), The Cambridge Companion to Vygotsky. New York, NY: Cambridge University Press, 2007, pp. 50-76.
• BANERJEE, Milinda. Decolonize Intellectual History! An Agenda for the Capitalocene, In: Journal of the History of Ideas Blog. Maryland, 21 May 2021. Available at: https://www.jhiblog.org/2021/05/19/decolonize-intellectual-history/?fbclid=IwAR1PIBMPayhmW1Vjzsfh6jDXdJfiR1i5PPT7n_RcpvNCCLymYHuZ6CjF0Hw Access: Aug 26, 2024.
  » https://www.jhiblog.org/2021/05/19/decolonize-intellectual-history/?fbclid=IwAR1PIBMPayhmW1Vjzsfh6jDXdJfiR1i5PPT7n_RcpvNCCLymYHuZ6CjF0Hw
• BASAGLIA, Franco; SCHEPER-HUGHES, Nancy; LOVELL, Anne M. (eds.) Psychiatry Inside Out: Selected Writings of Franco Basaglia. New York: Columbia University Press, 1987.
• BASAGLIA, Franco. Corpo e instituição: considerações antropológicas e psicopatológicas em psiquiatria institucional (1967). Rio de Janeiro: Garamond, 2005.
• BERESFORD, Peter; ROSE, Diana. Decolonising Global Mental Health: The Role of Mad Studies. Cambridge Prisms: Global Mental Health, Cambridge, v. 10, e30, pp. 1-8, 2010. DOI: 10.1017/gmh.2023.21. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10579658/. Access: Oct 30, 2023.
  » https://doi.org/10.1017/gmh.2023.21» https://pmc.ncbi.nlm.nih.gov/articles/PMC10579658
• BRANDIST, Craig. Carnival, Culture and Soviet Modernist Novel. St Antony’s Series. London, UK: Palgrave MacMillan UK, 1996.
• BRANDIST, Craig. Ethics, Politics and the Potential of Dialogism. Historical Materialism, London, v. 5, issue 1, pp. 231-253, 1999. Available at: https://brill.com/view/journals/hima/5/1/article-p231_8.xml Access: July 2, 2024.
  » https://brill.com/view/journals/hima/5/1/article-p231_8.xml
• BRANDIST, Craig. The Bakhtin Circle and the East (or What Bakhtinian Ideas Tell Us about ‘Decolonising the Curriculum’). Literaturovedcheskii zhurnal, Moscow, v. 54, n. 4, pp. 212-229, 2021. DOI: 10.31249/litzhur/2021.54.13. Available at: https://eprints.whiterose.ac.uk/184152/1/the-bakhtin-circle-and-the-east.pdf Access: Oct 30, 2023.
  » https://doi.org/10.31249/litzhur/2021.54.13» https://eprints.whiterose.ac.uk/184152/1/the-bakhtin-circle-and-the-east.pdf
• BRANDIST, Craig. The Bakhtin Circle: Philosophy, Culture and Politics. London, UK: Pluto Press, 2002.
• BRANDIST, Craig. The Vygotsky and Bakhtin Circles: Explaining the Convergence. In: ALANEN, Rikka; PÖYHÖNEN, Sari (eds.). Language in Action: Vygotsky and Leontievian Legacy Today. Newcastle, England: Cambridge Scholars Publishing, 2007. pp. 79-100.
• BRANDIST, Craig. Vološinov ‘s Dilemma: On the Philosophical Roots of the Dialogical Theory of the Utterance. In: BRANDIST, Craig; SHEPHERD, David; TIHANOV, Galin (eds.). The Bakhtin Circle: In the Master’s Absence. Manchester, UK: Manchester University Press, 2004. pp. 97-124.
• CARVALHO, Maria Aparecida Alves Sobreira; ARAÚJO, Sicilia Maria Moreira de; XIMENES, Veronica Morais; PASCUAL, Jesus Garcia. A formação do conceito de consciência em Vygotsky e suas contribuições à Psicologia. Arquivos Brasileiros de Psicologia, Rio de Janeiro, v.62, n.3, pp. 13-22, 2010. Available at: https://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S180952672010000300003&lng=pt Access: June 30, 2024.
  » https://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S180952672010000300003&lng=pt
• CELIKATES, Robin; FLYNN, Jeffrey. Critical Theory (Frankfurt School). In: The Stanford Encyclopedia of Philosophy. Stanford, December 12, 2023. Available at: https://plato.stanford.edu/entries/critical-theory/. Access: Oct 2, 2024.
  » https://plato.stanford.edu/entries/critical-theory
• COHEN, Bruce M. Z. Psychiatric Hegemony: A Marxist Theory of Mental Illness. London, UK: Palgrave MacMillan, 2016.
• CORNEJO, Carlos. Contrasting Vygotsky’s and Bakhtin’s Approaches to Consciousness. Culture & Psychology, California, v. 18, issue 1, pp. 109-120, 2012. Available at: https://journals.sagepub.com/doi/10.1177/1354067X11427470 Access: June 20, 2024.
  » https://journals.sagepub.com/doi/10.1177/1354067X11427470
• DAVIES, James. Political Pills: Psychopharmaceuticals and Neoliberalism as Mutually Supporting. In: DAVIES, James. The Sedated Society: The Causes and Harms of Our Psychiatric Drug Epidemic. Cham, Switzerland: Palgrave Macmillan, 2017. pp. 189-225.
• DAVIES, James. Sedated: How Modern Capitalism Caused Our Mental Health Crisis. London, UK: Atlantic Books, 2022.
• DAVIES, William. The Political Economy of Unhappiness. New Left Review, London, v. 71, pp. 65-80, Sept.-Oct./2011. Available at: https://newleftreview.org/issues/ii71/articles/william-davies-the-political-economy-of-unhappiness Access: June 20, 2024.
  » https://newleftreview.org/issues/ii71/articles/william-davies-the-political-economy-of-unhappiness
• DEACON, Brett J. The Biomedical Model of Mental Disorder: A Critical Analysis of Its Validity, Utility, and Effects on Psychotherapy Research. Clinical Psychology Review, Manchester, v. 33, n. 7, pp. 846-861, 2013. DOI: 10.1016/j.cpr.2012.09.007.
  » https://doi.org/10.1016/j.cpr.2012.09.007
• DELGADO, Pedro. Reforma psiquiátrica: estratégias para resistir ao desmonte. Trabalho, Educação e Saúde, Rio de Janeiro, v. 17, n. 2, 2019. DOI: 10.1590/1981-7746-sol00212. Available at: https://www.tes.epsjv.fiocruz.br/index.php/tes/article/view/856 Access: June 8, 2024.
  » https://doi.org/10.1590/1981-7746-sol00212» https://www.tes.epsjv.fiocruz.br/index.php/tes/article/view/856
• EMERSON, Caryl. Bakhtin and Vygotsky on Internalization of Language. The Quarterly Newsletter of the Laboratory of Comparative Human Cognition, San Diego, v. 5, n. 1, pp. 9-13, 1983. Available at: https://lchc.ucsd.edu/Histarch/ja83v5n1.PDF Access: June 7, 2024.
  » https://lchc.ucsd.edu/Histarch/ja83v5n1.PDF
• ENGEL, George L. The Need for a New Medical Model: A Challenge for Biomedicine. Science, New York, v. 196, n. 4286, pp. 129-136, 1977. Available at: https://doi.org/10.1126/science.847460 Access: June 7, 2025.
  » https://doi.org/10.1126/science.847460
• FERGUSON, Iain. Politics of the Mind: Marxism and Mental Distress. London, UK: Bookmarks Publications, 2017.
• FISHER, Mark. Capitalist Realism: Is There No Alternative? London, UK: Zero Books, 2009.
• FOOT, John. The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care. London: Verso, 1964.
• FOUCAULT, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. Translated from the French by Richard Howard. New York, USA: Vintage Books, 1965.
• FRIED, Eiko I. Studying Mental Health Problems as Systems, not Syndromes. Current Directions in Psychological Science, California, v. 31, issue 6, pp. 500-508, 2022. Available at: https://doi.org/10.1177/09637214221114089 Access: May 5, 2024.
  » https://doi.org/10.1177/09637214221114089
• GOLDSTEIN, E. Bruce. The Mind: Consciousness, Prediction, and the Brain. Cambridge, MA: The MIT Press, 2020.
• GORDON, Peter E; HAMMER, Espen; HONNETH, Axel (eds.). The Routledge Companion to the Frankfurt School. London, UK: Routledge, 2019. DOI: 10.4324/9780429443374.
  » https://doi.org/10.4324/9780429443374.
• HOLQUIST, Michael; EMERSON, Caryl (Ed.). Glossary. In: The Dialogic Imagination: Four Essays. Austin, TX: University of Texas Press, 1981.
• HOWARD, Michael Charles; KING, John Edward. The Political Economy of Marx. Harlow: Longman, 1975.
• JAMESON, Fredric. Postmodernism, or The Cultural Logic of Late Capitalism. New Left Review, London, v. 146, pp. 53-92, 1984. Available at: https://newleftreview.org/issues/i146/articles/fredric-jameson-postmodernism-or-the-cultural-logic-of-late-capitalism Access: July 2, 2024.
  » https://newleftreview.org/issues/i146/articles/fredric-jameson-postmodernism-or-the-cultural-logic-of-late-capitalism
• KELLOGG, David. ‘Classic Book’ Review: Marxism and the Philosophy of Language by V.N. Volosinov and Thinking and Speech, by L.S. Vygotsky. International Journal of Applied Linguistics, Leuven, v. 19, n. 1, pp. 84-96, 2009. Available at: https://lchc.ucsd.edu/mca/Mail/xmcamail.2009_03.dir/pdfECNR4Oa1nF.pdf Access: July 25, 2024.
  » https://lchc.ucsd.edu/mca/Mail/xmcamail.2009_03.dir/pdfECNR4Oa1nF.pdf
• KRAEPELIN, Emil. Psychiatrie: Ein kurzes Lehrbuch für Studirende und Aerzte. 4^th ed. Leipzig: A. Abel, 1893.
• LÄHTEENMÄKI, Mika. On the Interpretation of Baxtin’s Linguistic Ideas: The Problem of the Texts from the 1950-60s. Russian Linguistics, v. 27, n. 1, 2003, pp. 23-39. Available at: http://www.jstor.org/stable/40160678 Last access: Oct 24, 2024.
  » http://www.jstor.org/stable/40160678
• LEIMAN, Mikael. Mikhail Bakhtin’s Contribution to Psychotherapy Research. Culture and Psychology, California, v. 17, issue 4, pp. 441-461, 2011. Available at: http://cap.sagepub.com/cgi/content/abstract/17/4/441 Access: June 4, 2024.
  » http://cap.sagepub.com/cgi/content/abstract/17/4/441
• LEONT’EV, Aleksei Nikolayevich. On Vygotsky’s Creative Development. In: VYGOTSKY, Lev. The Collected Works of L. S. Vygotsky: Volume 3. Problems of the Theory and History of Psychology. Edited by Robert W. Reiber and Jeffrey Wollock. Translated by Van der Veer. New York, NY: Plenum Press, 1997. pp. 9-32.
• LINDQVIST, Gunilla. The Aesthetics of Play: A Didactic Study of Play and Culture in Preschools. Uppsala, Sweden: Uppsala University, 1995.
• MONCRIEFF, Joanna. The Political Economy of the Mental Health System: A Marxist Analysis. Frontiers in Sociology, Sec. Medical Sociology, Lausanne, v.6, 2022. Available at: https://doi.org/10.3389/fsoc.2021.771875 Access: Apr 9, 2024.
  » https://doi.org/10.3389/fsoc.2021.771875
• NATORP, Paul. Einleitung in die Psychologie nach kritischer Methode. Freiburg: J.C.B. Mohr (Siebeck), 1888.
• QUINTERO, Pablo; FIGUEIRA, Patricia; ELIZALDE, Paz Concha. A Brief History of Decolonial Studies. MASP Afterall, São Paulo, pp. 1-12, 2019. Available at: https://assets.masp.org.br/uploads/temp/temp-BxX9IYdiAvwShdOcVsAC.pdf Access: May 20, 2024.
  » https://assets.masp.org.br/uploads/temp/temp-BxX9IYdiAvwShdOcVsAC.pdf
• SAMPAIO, Mariá Lanzotti; BISPO JÚNIOR, José Patrício. Entre o enclausuramento e a desinstitucionalização: a trajetória da saúde mental no Brasil. Trabalho, Educação e Saúde, Rio de Janeiro, v. 19, p. 19, 2021. Available at: https://www.tes.epsjv.fiocruz.br/index.php/tes/article/view/546 Access: June 15, 2025.
  » https://www.tes.epsjv.fiocruz.br/index.php/tes/article/view/546
• THOMPSON, Michael J. The Palgrave Handbook of Critical Theory. New York: Palgrave Macmillan, 2017. DOI:10.1057/978-1-137-55801-5.
  » https://doi.org/10.1057/978-1-137-55801-5.
• VOLOŠINOV, Valentin Nikolaevich. Discourse in Life and Discourse in Art (Concerning Sociological Poetics). In: VOLOŠINOV, Valentin Nikolaevich. Freudianism: A Marxist critique. Translated by I. R. Titunik and edited in collaboration with Neal H. Bruss. New York: Academic Press, 1976. [1926]
• VOLOŠINOV, Valentin Nikolaevich. Marxism and the Philosophy of Language. Translated by Ladislav Matejka and I. R. Titunik. New York: Seminar Press New York and London, 1973. [1929]
• VYGOTSKY, Lev. The Collected Works of L. S. Vygotsky: Volume 4. History of the Development of Higher Mental Functions. Edited by Robert W. Reiber. New York, NY: Plenum Press, 1997. [1931]
• VYGOTSKY, Lev. The Collected Works of L. S. Vygotsky: Volume 1: Problems of General Psychology, Including the Volume Thinking and Speech. Edited by Robert W. Reiber and Aaron S. Carton. New York, NY: Plenum Press, 1987.
• WERTSCH, James V. Voices of the Mind: Sociocultural Approach to Mediated Action. Cambridge, MA: Harvard University Press, 1991.
• ZAVERSHNEVA, Ekaterina. The Problem of Consciousness in Vygotsky’s Cultural-Historical Psychology. In: YASNITSKY, Anton; VAN DER VEER, René; FERRARI, Michel (eds.). The Cambridge Handbook of Cultural-Historical Psychology. Cambridge, England: Cambridge University Press, 2014, pp. 63-97.
• ZAVERSHNEVA, Ekaterina. The Way to Freedom: Vygotsky in 1932. In: ASNITSKY, Anton; VAN DER VEER, René (eds.). Revisionist Revolution in Vygotsky Studies: The State of the Art. New York, NY: Routledge, 2016. pp. 127-140.

• Editors in charge
  Pietro Restaneo
  Laura Gherlone
  Regina Godinho de Alcântara

Data availability

The contents underlying the research text are included in the manuscript.

Publication Dates

• Publication in this collection
  09 Feb 2026
• Date of issue
  Jan-Mar 2026

History

• Received
  28 Oct 2024
• Accepted
  24 June 2025